Orthopedic plate, orthopedic device, method of coupling bone segments, and method of assembling an orthopedic plate

ABSTRACT

An orthopedic plate comprising, a frame portion and a bearing rotatably coupled with the frame portion, wherein the bearing defines an opening configured to receive a fastener for fastening the orthopedic plate to a body, wherein the bearing includes an outer surface that is eccentric to the opening such that a position of the opening with respect to the frame portion is adjustable as the bearing rotates.

CROSS-REFERENCE TO RELATED APPLICATION

This patent application claims the benefit under 35 U.S.C. §119(e) ofU.S. provisional patent application Ser. No. 61/569,052, filed Dec. 9,2011 and entitled ORTHOPEDIC PLATE, ORTHOPEDIC DEVICE. METHOD OFCOUPLING BONE SEGMENTS, AND METHOD OF ASSEMBLING AN ORTHOPEDIC PLATE,the entire contents of which are incorporated herein by reference.

FIELD

The present disclosure relates generally to devices for and methods ofrepairing bones and/or bone joints and methods of assembling saiddevices. More specifically, the disclosure relates to an orthopedicplate or an orthopedic device for coupling bone segments, a method ofdoing the same, and a method of assembling an orthopedic plate.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

When treating bone fractures, where a single bone is broken into two ormore bone segments, a medical professional often desires to promoteunion between the two or more bone segments. The same is the case when amedical professional desires to cause or help to cause bone fusions,i.e., uniting two bones into one bone by eliminating a jointtherebetween. When promoting union of two or more bone segments viastandard biologic healing, whether the bone segments are pieces of asingle bone or whether the bone segments are separate bones, it is oftendesirable to have precise alignment of bone segments and complete orsubstantially complete contact between the involved surfaces.

Alignment of the bone segments is desirable not only to enhance a unionof bone segments, but also to prevent or reduce the likelihood ofsubsequent deformity following union. If malalignment is created at thetime of fracture fixation, the ability of the bones to heal may becompromised and, if union is achieved, an alteration in forcedistribution may occur across formerly precisely balanced joints thatmay lead to increased contact stresses and subsequent arthritis. Jointsoften require precise balance to prevent portions of the cartilage fromaccelerated wear (wearing away the cartilage with repetitive cycles ofloading), which may lead to early onset arthritis.

Thus, under the above-mentioned circumstances, the ability of themedical professional to achieve an outcome that both the patient andclinician approve of is often directly related to the quality of thereduction of the bone segments.

Traditionally, medical professionals, such as orthopedic surgeons, useplate fixation to hold the various bone segments into the correctposition while they heal. The plates themselves are typically primarilyalignment devices. While they may provide some element of structuralsupport, if the fracture or fusion does not heal (nonunion), the plateand screw construct often eventually fails due to cyclic loading.

Dynamic compression plates have been used by medical professionals toattempt to promote biologic healing by creating a more complete andflush bond between bone segments. One type of dynamic compression plateincludes oblong, rather than circular, holes to allow the medicalprofessional to compress the fracture/fusion site by placing the screwagainst the side of the hole that is farthest from the fracture/fusionsite. This type of compression plate is utilized with fasteners, such asscrews, having a cone-shaped head with its largest diameter at the topof the fastener head. As the medical professional tightens the screwagainst the plate, the screw head engages the far end of the plate screwhole. Then, as the medical professional continues to tighten thefastener, the cone-shaped fastener head pushes the plate in a directionaway from the fracture/fusion site as long as two conditions are met:(1) the bottom side of the plate is in contact with the bone to preventthe plate from moving downward as the fastener moves downward, and (2)the other end of the plate is secured to the bone on the opposite sideof the fracture/fusion site.

The first of the above-mentioned conditions, namely that the bottom sideof the plate is in contact with the bone while the fastener is beingdriven downward into the bone, may diminish the plate's effectiveness orrender the plate unusable with bones that are not relatively flat. Forexample, as the medical professional tightens a fastener and causes theplate to contact an uneven bone surface, the bone may become distortedor otherwise damaged. Distortion of the fracture or fusion site mayalter the alignment of said site or may limit the contact surface areabetween the bone segments. In either case, the desired goal of anatomicrestoration of the bone or fusion site with maximal surface areaavailable for healing may not be achieved. As a result, this type ofdynamic compression plate may be undesirable for use with curved oruneven bone surfaces.

This type of dynamic compression plate may also be undesirable becausethe amount of compression is dependent on the screw height. In otherwords, the position of the plate along a first axis is dependent on theposition of the fastener along a second axis that is generallyperpendicular to the first axis. The dependent relationship between theplate and the screw height may not be desirable because it may preventthe medical professional from creating a desired compression forceacting on the bone segments while the fasteners are at their desiredpositions.

Therefore, it is desirous to provide an orthopedic plate, device, ormethod that can be used with bone segments having various shapes whileallowing dynamic compression of multiple bone segments and/or that canbe used to create a desired compression force acting on the bonesegments while the fasteners are at their desired positions.

SUMMARY

In overcoming the limitations and drawbacks of the prior art, thepresent orthopedic plate, device, and methods facilitate and/or providedynamic compression between multiple bone segments.

In one aspect, an orthopedic plate is provided, comprising a frameportion, and a bearing rotatably coupled with the frame portion, whereinthe bearing defines an opening configured to receive a fastener forfastening the orthopedic plate to a body, wherein the bearing includesan outer surface that is eccentric to the opening such that a positionof the opening with respect to the frame portion is adjustable as thebearing rotates, and wherein the bearing includes at least a first ridgethat is an anchoring ridge and a second ridge that is a locking ridge.

The anchoring ridge may have an inner diameter that is smaller than aninner diameter of the locking ridge. Furthermore, the anchoring ridgemay be configured to mate with a first set of fastener threads and thelocking ridge is configured to mate with a second set of fastenerthreads. The bearing may be configured to expand in diameter when thesecond set of fastener threads is received within the locking ridge.

The anchoring ridge may be configured to mate with a first set offastener threads and the locking ridge is configured to receive alocking head. The bearing may be configured to expand in diameter whenthe locking head is received within the locking ridge.

The orthopedic plate may also include a second bearing rotatably coupledwith the frame portion, wherein the second bearing defines a secondopening configured to receive a second fastener for further fasteningthe orthopedic plate to a body, wherein the second bearing includes anouter surface that is eccentric to the second opening.

In another aspect an orthopedic plate is provided, having a frameportion and a bearing rotatably coupled with the frame portion, whereinthe bearing defines an opening configured to receive a fastener forfastening the orthopedic plate to a body, wherein the bearing includesan outer surface that is eccentric to the opening such that a positionof the opening with respect to the frame portion is adjustable as thebearing rotates and wherein the bearing includes at least one key holeto facilitate rotation of the bearing with respect to the frame portion.

The bearing may include at least two key holes to facilitate rotation ofthe bearing with respect to the frame portion. The bearing may also beconfigured to facilitate rotation of the bearing with respect to theframe portion while the fastener is received within the opening.

In yet another aspect, an orthopedic device is provided, configured tofacilitate cutting at least one of first and second bone segments of abody and comprising a jig configured to be secured to the first andsecond bone segments of the body and a cutting guide coupled with thejig, wherein a position of the cutting guide with respect to the jig isadjustable along a first axis.

In another aspect, an orthopedic device is configured to facilitatecoupling first and second bone segments of a body and comprising a jighaving a first arm configured to be secured to the first bone segment, asecond arm configured to be secured to the second bone segment, and ajig adjustment mechanism configured to adjust the position of the firstarm with respect to the second arm to adjust a distance between thefirst and second bone segments.

In yet another aspect, a method of coupling first and second bonesegments of a body is provided, comprising coupling a first arm of a jigwith the first bone segment and coupling a second arm of the jig withthe second bone segment, coupling a cutting guide with the jig tofacilitate cutting at least one of the first and second bone segments,cutting at least one of the first and second bone segments, decouplingthe cutting guide from the jig, coupling a plate holding mechanism withthe jig, coupling an orthopedic plate with the plate holding mechanism,adjusting the plate holding mechanism so as to move the orthopedic plateinto a desired position with respect to the first and second bonesegments, securing a first portion of the orthopedic plate to the firstbone segment and securing a second portion of the orthopedic plate tothe second bone segment, adjusting at least one of the following: aposition of at least one of the first and second arms of the jig so asto adjust a distance between the first and second bone segments and aplate adjusting mechanism to adjust a distance between the first andsecond bone segments.

Further objects, features and advantages of the orthopedic plate,device, and method will become readily apparent to persons skilled inthe art after a review of the following description, with reference tothe drawings and claims that are appended to and form a part of thisspecification.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

In order that the disclosure may be well understood, there will now bedescribed various forms thereof, given by way of example, referencebeing made to the accompanying drawings, in which:

FIG. 1 shows an isometric view of an orthopedic device embodyingprinciples of the present invention and having a jig with first andsecond arms and an orthopedic plate;

FIG. 2 is a top view of the orthopedic device shown in FIG. 1;

FIG. 3 is a front view of the orthopedic device shown in FIG. 1;

FIG. 4 is a side view of the orthopedic device shown in FIG. 1;

FIG. 5a is a top view of the orthopedic plate shown in FIG. 1 wherefirst and second bearings of the orthopedic plate are each in anon-compressed position;

FIG. 5b is a top view of the orthopedic plate shown in FIG. 1 where thefirst and second bearings of the orthopedic plate are each in acompressed position;

FIG. 6 is a cross-sectional view of the orthopedic plate shown in FIG.5b taken along line 6-6;

FIG. 7 is an isometric view of an alternative embodiment of anorthopedic device coupled with first and second bone segments of apatient's body;

FIG. 8 shows the orthopedic device shown in FIG. 7, further including acutting guide coupled with the jig;

FIG. 9 shows the orthopedic device shown in FIG. 7, further including asurgical saw received within a slot of the cutting guide;

FIG. 10 shows the orthopedic device shown in FIG. 7, where portions ofthe first and second bone segments have been removed to formcomplimentary bonding surfaces;

FIG. 11 shows the orthopedic device shown in FIG. 7, where a medicalprofessional is adjusting the position of the jig first arm with respectto the jig second arm, thereby adjusting the position of the first bonesegment with respect to the second bone segment;

FIG. 12 shows the orthopedic device shown in FIG. 7, where the medicalprofessional has adjusted the position of the jig first arm with respectto the jig second arm such that the first and second bone segments areabutting each other;

FIG. 13 shows the orthopedic device shown in FIG. 7 coupled with a plateholding mechanism, where the plate holding mechanism is configured toposition an orthopedic plate with respect to the first and second bonesegments;

FIG. 14 shows the orthopedic device shown in FIG. 7, further includingdrill guides coupled with the orthopedic plate and where the medicalprofessional is drilling along the drill guides and into the first andsecond bone segments;

FIG. 15 shows the orthopedic device shown in FIG. 7, where a medicalprofessional is securing the orthopedic plate to the first and secondbone segments;

FIG. 16 shows the orthopedic plate shown in FIG. 15, where the jig andorthopedic plate holding mechanism have been decoupled from theorthopedic plate;

FIG. 17 shows an isometric view of the orthopedic plate shown in FIG. 15and a plate adjustment mechanism configured to mate with the orthopedicplate and adjust the position of bearings therein;

FIG. 18 shows an isometric view of the orthopedic plate and plateadjustment mechanism shown in FIG. 17, where the orthopedic plate andplate adjustment mechanism are mated with each other;

FIG. 19 shows an isometric view of the underside of the bearing for theorthopedic plate shown in FIG. 17;

FIG. 20 shows the bearing being coupled with the orthopedic plate frame;

FIG. 21 shows the bearing coupled with the orthopedic plate frame;

FIG. 22 shows a fastener configured to couple an orthopedic plate to oneor more bone segments, wherein the fastener includes first and secondthreads;

FIG. 23 shows an alternative embodiment of an orthopedic plate embodyingprinciples of the present invention;

FIG. 24 is another alternative embodiment of an orthopedic plateembodying principles of the present invention;

FIG. 25 is a fastener coupled with the orthopedic plate shown in FIG.24;

FIG. 26 is a cross-sectional view of the orthopedic plate shown in FIG.24 taken along line 26-26; and

FIG. 27 is an alternative embodiment of a fastener configured to couplean orthopedic plate to one or more bone segments.

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses.

Referring now to the drawings, FIG. 1 shows an orthopedic device 10 forcoupling bone segments of a patient's body. The orthopedic device 10includes a jig 12, an orthopedic plate 14, and a plate holding mechanism16. Although these components are shown being used with each other, manyor all of the components may be used independently of each other. Forexample, a medical professional may choose to use the orthopedic plate14 without using the jig 12 or may choose to use the jig 12 with anotherorthopedic plate or another device altogether.

The jig 12 shown in the figures is coupled with the patient's body tofacilitate installation of the orthopedic plate 14. The jig 12 shown inthe figures includes a first portion 18 having a first arm 20 that isable to be coupled with the patient's body and a second portion 22having a second arm 24 that is also able to be coupled with thepatient's body.

For example, FIG. 7 shows a patient's body 26, particularly a patient'sfoot, having a first bone segment 28 and a second bone segment 30 thathave been separated via a fracture 32. In the embodiment of the jig 12shown in FIG. 7, the first and second arms 20, 24 each have two fastenerholes 21 a, 21 b, 23 a, 23 b that may be used to secure the jig 12 tothe bone segments, whereas the first and second arms 20, 24 of the jig12 shown in FIG. 1 each include one fastener hole 25 a, 25 b. Althoughthe figures focus on the foot portion of the patient's body 26, thepresent invention may be used with any suitable portion of a patient'sbody, such as the hands, ankles, wrists, legs, arms, oral ormaxillofacial areas, or any other portion of a patient's body. Thepatient shown in the drawings is human, but the devices and methodsdisclosed herein may also be used on animals, such as throughveterinarian medicine, and thus the term “medical professional” includesall types of medicine, including veterinarian medicine.

Referring to FIG. 7-16, although these figures show first and secondbone segments 28, 30 of a metatarsal bone that have been separated via afracture 32, the present invention may be used with any suitable injury,condition, disease, malady, or weakness to a patient's body, such as afracture, fusion, crack, or damaged joint. The term “bone segments” mayrefer to two portions of a single bone or two different bones. Themetatarsal bone shown in the figures is, for illustrative purposes,longer and extends more proximal than a typical metatarsal bone in anormal adult patient. Also, for illustrative purposes, other bones ofthe patient's foot are not shown. If the jig 12 was used for a fusionapplication, rather than a fracture, in a similar area of a patient'sfoot, then the first and second arms of the jig likely would be securedto a metatarsal distally and a cuneiform proximally. However, asdiscussed above, the orthopedic device 10 may be used with any suitablebone segments.

Referring to FIGS. 1-4, the second portion 22 of the jig 12 is slidablyreceived within the first portion 18 so that the respective portions 18,22 are movable with respect to each other. The first and second portions18, 22 shown in the figures further include a jig adjustment mechanism34 and a locking key 36 for adjusting a distance 38 between the firstarm 20 and the second arm 24 of the jig 12. The locking key includes alocked position 36 a (FIGS. 1-4, 8-10, 12-15), in which the first andsecond portions 18, 22 of the jig 12 are movable with respect to eachother, and an unlocked position 36 b (FIGS. 7 and 11), in which thefirst and second portions 18, 22 of the jig 12 are not movable withrespect to each other. The jig 12 shown in the figures also includes agear 40 and track 42, such as a rack and pinion, that cooperate todefine the jig adjustment mechanism 34, but any other suitableadjustment mechanism may be used. The gear 40 in the figures is locatedwithin a cavity defined by the jig first portion 18 and is accessiblefrom outside the jig 12 via a key hole 44 in the jig 12. The orthopedicdevice 10 further includes an adjustment key 46 (FIGS. 4, 11) configuredto be inserted into the key hole 44 (FIGS. 2, 8-10) and rotate the gear40, thereby adjusting the distance 38 between the first and second arms20, 24. When the jig 12 is coupled with the first and second bonesegments 28, 30, by turning the adjustment key 46, a medicalprofessional is able to adjust the relative position of the first andsecond bone segments 28, 30 with respect to each other. As a result, amedical professional is able to use the jig 12 to cause the first andsecond bone segments to dynamically compress, or cause the bone segments28, 30 to come into contact with each other, and potentially promotebiological healing.

As best shown in FIGS. 1 and 2, the plate holding mechanism 16 iscoupled to the jig 12 via a tab-slot connection 48 and securing pin 50(FIG. 2) which secures the tab-slot connection 48. The plate holdingmechanism 16 further includes a vertical adjustment mechanism 52configured to adjust the position of the orthopedic plate 14 along ay-axis 54 (FIG. 1). For example, the vertical adjustment mechanism 52shown in the figures includes a tab-slot connection 56 and securing pin58 securing the tab-slot connection 56 (FIG. 1). The plate holdingmechanism 16 further includes a horizontal adjustment mechanism 60configured to adjust the position of the orthopedic plate 14 along anx-axis 62 (FIG. 1). For example, the horizontal adjustment mechanism 60shown in the figures includes a tab-slot connection 64 and securing pin66 securing the tab-slot connection 64 (FIG. 1). By using the verticaladjustment mechanism 52 and the horizontal adjustment mechanism 60, amedical professional is able to adjust the position of the orthopedicplate 14 with respect to the first and second bone segments 28, 30 so asto properly align the orthopedic plate 14 before coupling it with thebone segments 28, 30. In an alternative embodiment, the verticaladjustment mechanism and the horizontal adjustment mechanism includegear and track mechanisms such as the rack and pinion mechanismdiscussed with respect to the jig adjustment mechanism 34.

As is best shown in FIGS. 5a and 5b , the orthopedic plate 14 includes aframe portion 68 and first and second plate adjustment mechanisms 78, 79that are each configured to adjust a distance 80 (FIG. 16) between firstand second fasteners 74, 76 (FIGS. 15, 16), respectively. The plateadjustment mechanisms 78, 79 shown in the figures include a firstbearing 84 that is rotatable with respect to the frame portion 68 and asecond bearing 86 that is rotatable with respect to the frame portion68.

The orthopedic plate 14 shown in the figures defines a first opening 70and a second opening 72 that are configured to receive the first andsecond fasteners 74, 76, to couple the orthopedic plate 14 to the firstand second bone segments 28, 30. The distance 80 is measured at thecenter of each of the fasteners 74, 76 and is therefore, in theembodiments shown in the figures, the same distance as that measuredfrom the respective centers of each of the openings 70, 72 (FIGS. 5a, 5b).

As best shown in FIGS. 5a, 5b , and 6, the first and second bearings 84,86 each include two annular ridges: a anchoring ridge 65 and a lockingridge 67. The anchoring ridge 65 defines the opening 70, 72 in each ofthe bearings 84, 86. As best shown in FIG. 22, the fasteners 74, 76 eachinclude two sets of threads: anchoring threads 69, 73 and lockingthreads 71, 75. The anchoring threads 69, 73 are configured to mate withthe anchoring ridges 65 in the first and second bearings 84, 86,respectively, while the fasteners 74, 76 are being screwed into the bonesegments 28, 30. The locking threads 71, 75 are configured to mate withthe locking ridge 67 when the fasteners 74, 76 are substantially orcompletely screwed down into the bone segments 28, 30 so as to preventthe bearings from rotating with respect to the plate portion 68. Morespecifically, the diameter of the locking threads 71, 75 is sized so asto cause the bearings 84, 86 to expand and form a friction engagementwith the plate portion 68. The bearings 84, 86 are able to rotate withrespect to the plate portion 68 except when the locking threads 71, 75cause the bearings 84, 86 to expand and form a friction engagement withthe plate portion 68. The locking feature of the fasteners 74, 76 makeit easier and more effective for the medical professional to “float” theorthopedic plate 14 above the bone segments 28, 30 (i.e., to space theplate 14 apart from the bone segments 28, 30). The locking feature ofthe fasteners 74, 76 also may improve or stabilize the connectionbetween the bone segments 28, 30, even when a jig 12 is not being used.The locking feature also prevents or minimizes undesired rotation thebearings 84, 86 after the plate 14 has been installed.

Referring to FIGS. 5a and 5b , the bearings 84, 86 each include an outersurface 88, 90 that is eccentric to the inner surface (e.g., theanchoring ridge 65) of the bearing 84, 86. In other words, the outersurface 88, 90 of the bearings 84, 86 and the anchoring ridge 65 eachgenerally define circles that have different centerpoints. As a result,the distance 80 is adjusted as one of the bearings 84, 86 is rotatedwith respect to the frame portion 68. A medical professional is able touse the orthopedic plate 14 to cause the first and second bone segments28, 30 to dynamically compress, or cause the bone segments 28, 30 tocome into contact with each other, and potentially promote biologicalhealing.

The plate adjustment mechanism 78 shown in the figures is configured tobe able to adjust the distance 80 while the orthopedic plate 14 isspaced apart from at least one of the first and second bone segments 28,30, as is measured generally along a fastener axis 82 (FIG. 15). Inother words, the orthopedic plate 14 does not need to abut the bonesegments 28, 30 to be able to adjust the distance 80, thereby permittingdynamic compression of the bone segments 28, 30 while minimizing,reducing, or avoiding distortion to the bone segments 28, 30 by theorthopedic plate 14. Utilizing the orthopedic plate 14 in this mannermay be particularly advantageous where the bone segments 28, 30 areuneven along the length of the orthopedic plate 14. However, theorthopedic plate 14 is also usable and adjustable when it is abuttingthe bone segments 28, 30. In some cases, such as where the bone segments28, 30 are relatively flat, it may be desirable for the orthopedic plate14 to abut the bone segments 28, 30.

As is illustrated in FIGS. 5a and 5b , the distance 80 is largest (andthe orthopedic plate 14 offers the least amount of compression) when thefirst and second bearings 84, 86 are each rotated such as to be in anon-compressed position 94 (i.e., where the centerpoints of the firstand second bearings 84, 86 are furthest from each other). Conversely,the distance 80 is smallest (and the orthopedic plate 14 offers themaximum amount of compression) when the first and second bearings 84, 86are each rotated such as to be in a compressed position 96 (i.e., wherethe centerpoints of the first and second bearings 84, 86 are closest toeach other). Each of the first and second bearings 84, 86 defines acompression adjustment distance 98. The compression adjustment distance98 is the distance measured along the longitudinal axis of theorthopedic plate 14 between the centerpoint of a bearing in thenon-compressed position 94 and the compressed position 96. The distance80 is therefore adjustable by an amount equal to the compressionadjustment distance 98 of the first bearing 84 plus the compressionadjustment distance 98 of the second bearing 86. In the embodiment shownin FIGS. 5a and 5b , the orthopedic plate 14 has a compressionadjustment distance of approximately 1.5 millimeters, thereby allowing amedical professional to adjust the distance 80 of the orthopedic plate14 by approximately 3.0 millimeters.

Another advantage to the orthopedic plate 14 shown in FIGS. 5a and 5b isthat it allows a medical professional to adjust a horizontal distance(i.e., the distance 80) of the first and second fasteners 74, 76independently of a vertical positioning (i.e., the position of thefasteners 74, 76 along the fastener axis 83) of the first and secondfasteners 74, 76. This configuration allows a medical professional tohave more control over the position (both horizontally and vertically)of the orthopedic plate 14 when coupling the same with the first andsecond bone segments 28, 30.

The orthopedic device 10 shown in the figures also includes a cuttingguide 100 coupled with the jig 12 and configured to guide a surgical saw102 or other cutting instrument. For example, the cutting guide 100 hasa pair of cutting slots 104, 106 configured to receive the surgical saw102 and allow a medical professional to cut through the bone segments28, 30 in a relatively straight line by following the slots 104, 106.Often times, a medical professional will desire or need to cut opposingfaces of bone segments 28, 30 so as to create two complimentary surfacesthat will easily and effectively achieve a union through normalbiological healing. It is often advantageous for the complimentarysurfaces to be flat surfaces that are generally perpendicular to thelongitudinal axis of the bone(s). The cutting guide is adjustable alongthe y-axis 54 (FIG. 1) by way of a tab-slot connection 108 and asecuring pin 110 (FIG. 8). The cutting guide is adjustable along thex-axis 62 (FIG. 1) by way of the jig adjustment mechanism 34 (FIG. 1).

For illustrative purposes, a method of coupling first and second bonesegments 28, 30 of a patient's body 26 is herein described. A medicalprofessional (generally designated by numeral 120 in FIG. 11) makes anincision in the patient's body 26 and exposes the bone segments 28, 30to be coupled via clamps 122, 124. As shown in FIG. 7, the medicalprofessional couples the first arm 20 of the jig 12 with the first bonesegment 28 and couples the second arm 24 of the jig 12 with the secondbone segment 30 by using fasteners 126, 128. Tuming to FIGS. 8 and 9,the medical professional then couples the cutting guide 100 with the jig12 to facilitate cutting at least one of the first and second bonesegments 28, 30 with the surgical saw 102. For example, the cuttingguide 100 may be coupled with the jig 12 via a setscrew 129 (FIGS. 2, 9)and a dovetailed holding clamp 131 (FIG. 9). The cutting slots 104, 106shown in the figures are approximately 3.0 millimeters apart from eachother, but may have any suitable distance therebetween. Also, themedical professional can adjust the distance between the two cuts bymaking a first cut in the first bone segment 28 and then horizontallyadjusting the position of the cutting guide 100 via the securing pin110. The medical professional then decouples the cutting guide 100 fromthe jig 12.

As shown in FIG. 10, after cutting the bone segments 28, 30 preferablyhave flat, complimentary surfaces 130, 132 that will promote union whensaid surfaces are compressed together. As shown in FIG. 11, with thelocking key 36 in the unlocked position 36 b, the medical professional120 rotates the adjustment key 46 so as to move the first and secondarms 20, 24 with respect to each other. For example, the medicalprofessional 120 rotates the adjustment key 46 until the bone segments28, 30 are in contact with each other or close to being in contact witheach other. The medical professional may also, or alternatively, adjustthe distance between the bone segments 28, 30 by unlocking the lockingkey 36 and manually pressing together or pulling apart the first andsecond portions of the jig 12.

Once the arms 20, 24 of the jig 12 are positioned as desired, themedical professional then moves the locking key 36 into the lockedposition 36 a (FIG. 12) thereby coupling the plate holding mechanism 16with the jig 12. The medical professional can adjust the horizontal orvertical position of the orthopedic plate 14 via the vertical adjustmentmechanism 52 and the horizontal adjustment mechanism 60, respectively.

As shown in FIG. 14, once the orthopedic plate 14 is in the desiredposition with respect to the bone segments 28, 30, the medicalprofessional secures drilling guides 134, 136 to the orthopedic plate 14and uses a surgical drill 138 to drill through the drill guides 134, 136and into the bone segments 28, 30. The drilling guides 134, 136 shown inthe figures are perpendicular to the orthopedic plate 14 and are coupledtherewith by a threaded connection. Specifically, the drilling guides134, 136 mate with the locking ridge 67. The inside diameter of thedrilling guides 134, 136 corresponds to the diameter of the first andsecond openings 70, 72 (i.e., the diameter defined by the anchoringridge) to assist with alignment of the drill bit as it creates holes inthe bone segments 28, 30. The medical professional then removes thedrilling guides 134, 136 from the orthopedic plate 14 and, as is shownin FIG. 15, secures a first portion of the orthopedic plate 14 to thefirst bone segment 28 and secures a second portion of the orthopedicplate 14 to the second bone segment 30. For example, the medicalprofessional shown in FIG. 15 is securing the orthopedic plate 14 to thebone segments 28, 30 via the fasteners 74, 76 and a screwdriver 140.

When the fastener heads are flush with the bearings, the bearingsoutwardly expand, thereby locking the bearings in place with respect tothe orthopedic plate frame portion and prevent rotation of the bearing.When the bearing is expanded (and thus locked) it forms an interferencefit with the orthopedic plate frame portion, thereby substantially orcompletely preventing the bearing from back spinning into anuncompressed position under physiologic loads. The bearings 84, 86include bearing key holes 148, 150 that facilitate rotation of thebearings 84, 86, as well as facilitate compression of the bone segments28, 30, as will be described in more detail below. In other words, thefirst and second bearings 84, 86 are configured to facilitate rotationof the bearings with respect to the frame portion 68 while the fasteners74, 76 are received within the first and second openings 70, 72,respectively.

Next, the plate holding mechanism 16 is decoupled from the orthopedicplate 14 and the jig is decoupled from the bone segments 28, 30. Themedical professional then, if desired, uses the first and/or secondplate adjustment mechanisms 78, 79 to adjust the distance 80 between thefirst and second bone segments 28, 30. For example, as shown in FIGS.16-18, the medical professional first loosens the fastener by at leastone-half of a turn to unlock the bearing with respect to the frameportion. The medical professional may then use a bearing key 142 torotate the first and/or second bearings 84, 86 with respect to the frameportion 68 of the orthopedic plate 14. The bearing key 142 shown in thefigures includes a first key tooth 144 and a second key tooth 146 thatcorrespond to and fit within the bearing key holes 148, 150,respectively. The bearing key holes 148, 150 are spaced apart and shapedso as to permit the medical professional to apply a torque force thereonand rotate the bearings 84, 86, thereby permitting dynamic compressionof the bone segments 28, 30. For example, the bearing key holes 148, 150shown in the figures are generally opposite each other on the bearings84, 86. Additionally, the bearing key holes 148, 150 shown in thefigures have a generally curved shape to promote a torque force on thebearings 84, 86.

The desired distance 80 may vary depending on various circumstances, butit is typically 0.00 to 0.05 millimeters. After rotationally adjustingthe bearings and obtaining a desired distance 80 and, if applicable,compression force, the medical professional tightens the fasteners sothe fastener heads are flush with the bearings and the bearings arelocked with respect to the frame portion. The fastener heads shown inthe figures are conical, but they may be flat or any other shape.

As shown in FIGS. 19-21, the bearing 84 may be coupled with the frameportion 68 of the orthopedic plate 14 via a spring connection. Forexample, the bearing has a notch 152 that allows the bearing to act likea C-shaped spring and compress and expand depending on the lateral forceapplied. The bearing 84 is inserted within a guide sleeve 154 that iscoupled with or positioned flush with the frame portion 68 of theorthopedic plate 14. A punch mechanism 156 pushes down on the bearing 84and forces it downward in the guide sleeve 154, until the bearing 84 isin a desired position with respect to the frame portion 68. For example,in the embodiment shown in the figures, the bearing 84 is in the desiredlocation when an outer surface 85 of the bearing contacts an innersurface 87 of the frame portion 68. More specifically, in the embodimentshown in the figures, the bearing 84 is in the desired location when itsnaps into place in the frame portion 68. The outer surface 85 of thebearing 84 includes a notch 89 that is configured to mate with a ring 91in the inner surface 87 of the frame portion 68 to secure the bearing 84with respect to the frame portion 68. The guide sleeve 154 shown in thefigures includes an inner wall 155 that is tapered inwardly to increasethe compression of the bearing 84 as it is forced downward by the punchmechanism 156.

In one alternative embodiment, as shown in FIG. 23, an orthopedic plate214 is provided having a bearing 268 with a first notch 352 in oneportion of the bearing 268 and a second notch 356 diametrically opposedto the first notch 352 to alter the spring coefficient of the bearing268 compared to the bearing shown in the prior figures. The bearing keyholes 348, 350 are also larger than those shown in the prior figures anddefine portions of the outer surface of the bearing 268.

In another alternative embodiment, as shown in FIGS. 24-26, anorthopedic plate 414 is provided having a frame portion 468 and firstand second plate adjustment mechanisms 478, 479 that are each configuredto adjust a distance between first and second fasteners received withinthe plate adjustment mechanisms 478, 479. The plate adjustmentmechanisms 478, 479 shown in the figure include first and second bearing484, 486 that are each rotatable with respect to the frame portion 468.The frame portion 468 is generally curved along a longitudinal axis 410so as to match the curvature of a bone. The orthopedic plate 414 alsodefines openings 412, 413, 414 for receiving fasteners and therebyfurther securing the orthopedic plate 414 to the bone. Alternatively,the opening 413 may be used as a connection point to a jig 12 or otherdevice.

As shown in FIG. 27, in an alternative design, fasteners 174, 176include a locking head 171, 175 configured to be received by the lockingridge 67 of the bearings. The locking head 171, 175 is tapered so as toincrease the radially expansion of the diameter of the bearings as thelocking head 171, 175 is driven downward with respect to the orthopedicplate. As with the locking threads 71, 75, the locking heads 171, 175are configured to mate with the locking ridge 67 when the fasteners 174,176 are substantially or completely screwed down into the bone segments28, 30 so as to prevent the bearings from rotating with respect to theplate portion 68. More specifically, the diameter of the locking threads171, 175 is sized so as to cause the bearings 84, 86 to expand and forma friction engagement with the plate portion 68. The bearings 84, 86 areable to rotate with respect to the plate portion 68 except when thelocking threads 171, 175 cause the bearings 84, 86 to expand and form afriction engagement with the plate portion 68.

FIG. 25 shows another alternative design for a fastener 374, where alocking head 371 is tapered so as to increase the radially expansion ofthe diameter of the bearings as the locking head 371 is driven downwardwith respect to the orthopedic plate 414. Additionally, the locking head371 includes threads 372 configured to mate with threads in theorthopedic plate 414.

It should be noted that the disclosure is not limited to the embodimentdescribed and illustrated as examples. A large variety of modificationshave been described and more are part of the knowledge of the personskilled in the art. These and further modifications as well as anyreplacement by technical equivalents may be added to the description andfigures, without leaving the scope of the protection of the disclosureand of the present patent.

1. (canceled)
 2. A method of mounting an orthopedic plate assembly to a body, comprising: positioning a frame portion of the orthopedic plate assembly against a body; coupling a bearing to the frame portion such that the bearing is rotatable with respect to the frame portion, the bearing comprising an opening that defines a longitudinal direction of travel; advancing a fastener along the longitudinal direction of travel to fasten the frame portion to the body, wherein the fastener contacts the bearing causing the bearing to radially expand and become non-rotatably coupled to the frame portion.
 3. The method of claim 2, further comprising: rotating the bearing with respect to the frame portion independent of the fastener; wherein the opening of the bearing is eccentric to an outer surface of the bearing such that rotation of the bearing causes a position of the opening to adjust with respect to the frame portion.
 4. The method of claim 3, further comprising: mating a notch on the outer surface of the bearing with a ring on an inner surface of the frame portion; and rotating the bearing caused the notch to slide past the ring.
 5. The method of claim 4, wherein the notch is situated midway between a top surface and a bottom surface of the bearing.
 6. The method of claim 4, wherein a top surface of the bearing is flush with a top surface of the frame portion along a circumference of the bearing.
 7. The method of claim 2, wherein the bearing provides a first key hole and a second key hole spaced apart in the bearing and positioned between the opening and the outer surface of the bearing.
 8. The method of claim 7, wherein the first key hole and the second key hole each extend circumferentially around a portion of a circumference of the bearing.
 9. The method of claim 2, wherein coupling the bearing to the frame portion comprises snapping the bearing into place within the frame portion at a set vertical position within the frame portion.
 10. The method of claim 9, wherein the bearing is rotatable with respect to the frame portion while maintaining the bearing at the set vertical position in the frame portion.
 11. The method of claim 2, wherein the bearing further comprises: at least a first annular-shaped ridge projecting into the opening of the bearing to provide a first inner diameter within the opening, and a second annular-shaped ridge projecting into the opening of the bearing to provide a second inner diameter within the opening.
 12. The method of claim 11, wherein the first inner diameter is located in a first plane and the second inner diameter is located in a second plane; and the first plane and the second plane are perpendicular with respect to the longitudinal direction of travel and are spaced apart along the longitudinal direction of travel.
 13. The method of claim 11, wherein the fastener includes a tapered head section; and advancing the fastener along the longitudinal direction of travel causes the tapered head section to contact the second ridge and gradually expand the second ridge outward so as to provisionally lock the bearing to the frame portion.
 14. The method of claim 11, wherein a distal end of the fastener comprises a first set of fastener threads for entering bone, and a proximal end of the fastener comprises a locking head having a second set of fastener threads.
 15. The method of claim 14, wherein advancing the fastener along the longitudinal direction of travel causes the locking head to contact the second ridge to lock the locking head to the second ridge.
 16. The method of claim 11, wherein the second inner diameter is larger than the first inner diameter.
 17. The method of claim 2, further comprising: coupling a second bearing to the frame portion such that the second bearing is rotatable with respect to the frame portion, the second bearing defining a second opening; and advancing a second fastener into the second opening to further fasten the frame portion to the body.
 18. The method of claim 17, further comprising: rotating the second bearing with respect to the frame portion; wherein the second opening of the bearing is eccentric to an outer surface of the second bearing such that rotation of the second bearing causes a position of the second opening to adjust with respect to the frame portion.
 19. A method of mounting an orthopedic plate assembly to a body, comprising: positioning a frame portion of the orthopedic plate assembly against a body; coupling a bearing to the frame portion such that the bearing is rotatable with respect to the frame portion, the bearing comprising an opening that defines a longitudinal direction of travel; advancing a fastener along the longitudinal direction of travel and causing the fastener to radially expand the bearing, thereby rotatably coupling the bearing to the frame portion; rotating the bearing with respect to the frame portion independent of the fastener; wherein the opening of the bearing is eccentric with respect to an outer surface of the bearing such that rotation of the bearing causes a position of the opening to adjust with respect of the frame portion.
 20. A method of mounting an orthopedic plate assembly to a body, comprising: positioning a frame portion of the orthopedic plate assembly against a body; coupling a first bearing to the frame portion such that the first bearing is rotatable with respect to the frame portion independent of the first fastener, the first bearing comprising a first opening that defines a longitudinal direction of travel; advancing a first fastener along the longitudinal direction of travel and causing the first fastener to radially expand the first bearing, thereby coupling the first bearing to the frame portion; coupling a second bearing to the frame portion such that the second bearing is rotatable with respect to the frame portion, the second bearing defining a second opening; advancing a second fastener into the second opening to further fasten the frame portion to the body; and rotating the second bearing with respect to the frame portion independent of the second fastener; wherein the second opening of the second bearing is eccentric with respect to an outer surface of the second bearing such that rotation of the second bearing causes a position of the second opening to adjust with respect of the frame portion. 